Flashcards in Peds - Eyes and Ears Deck (52):
A common staphlococcal abcess on upper or lower eyelid with ABRUPT onset; PAINFUL
Hordeolum / Stye
When to refer hordeolum?
If no resolution within 48 hours
Management of hordeolum
Consider bacitracin on erythromycin ophthalmic ointment
A non-tender beady nodule (granuloma) on the eyelid; c/b infection or retention cyst of the meibomian gland
Management of chalazion
Refer for surgical removal
Chalazion - signs and symtoms
PAINLESS and may have:
Visual distortion if pressing on lens
Conjunctivitis with purulent discharge is associated with:
Conjunctivitis with COPIOUS purulent discharge is associated with:
Conjunctivitis with stringy discharge is associated with:
Conjunctivitis with watery discharge is associated with:
Conjunctivitis which is bright red and irritated is associated with:
Treatment of CHEMICAL conjunctivitis
flush with water
Treatment of BACTERIAL conjunctivitis
o erythromycin ophthalmic
o polymyxin B ophthalmic
Treatment of GONOCOCCAL conjunctivitis (2)
Penicillin G - IV
Ceftriaxone - IM
Treatment of CHLAMYDIAL conjunctivitis
(2 with examples of second - class and drugs)
o erythromycin ophthalmic OINTMENT
o ORAL therapy - tetracyclines or macrolides
Treatment of ALLERGIC conjunctivitis
o oral antihistamines
o refer to allergy and ophthamology
Why are ophthalmic steroids not used in primary care for conjuncitivitis?
increased intraocular pressure
activation of herpes simplex virus
When should conjunctivitis be cultured?
baby under 30 days old
suspect gonorrheal cause in any age
Treatment of VIRAL conjunctivitis
mild --> refrigerated NSS gtts
mod --> decongestants, antihistamines, mast cell stabilizers, NSAIDS
severe --> sulfacetamide for bacterial prophylaxis
Treatment for HERPETIC conjunctivitis
Refer to ophthamlogist
An abnormal, uniform, progressive opacity of the eye often seen with co-morbid conditions.
What co-morbid conditions are associated with CATARACTS?
o Down's syndrome
o Atopic dermatitis
Possible causes of cataracts
o prolonged steroid use
NP management of cataracts
Refer for surgery
Ocular misalignment as a result of uncoordinated ocular muscles
Strabismus / lazy eye
When is strabismus a concern?
o prior to 6 months, considered WNL
o if acquired after 6 months, usually due to underlying problem
What finding in strabismus is associated with a brain tumor?
hypertropia - eyes deviate upward
hypotropia - eyes deviate downward
A rapidly developing cancer that develops from the immature cells of a retina; the most common malignant tumor of the eye in children.
Recognize and Refer
Inflammation of the external auditory meatus
Otitis externa / Swimmer's ear
Possible causes of otitis externa
Otitis externa - signs and symptoms
o purulent drainage
Management of otitis externa (2)
bacterial --> acetic acid + hydrocortisone
cortisporin (neomycin, polymyxin)
fungal --> clotrimazole solution
Microbes commonly implicated in acute otitis media
S. pneumoniae - 30%
H. influenza - 20%
Pain management for otitis media
o benzocaine otic gtts
When is "watchful waiting" appropriate for acute otitis media?
o child over 4
o parent educated about red flags
Red flags during watchful waiting in AOM?
o change in appetite
Treatment for acute otitis media (1)
Prevention of acute otitis media
o influenza vaccine
o avoid second hand smoke
When to refer to ENT for possible tubes in acute otitis media?
3x / year
2x / 6 mo
The presence of fluid in the middle ears without the signs or symptoms of AOM.
Serous otitis media / Otitis media with effusion
Weber / Rinne results indicate which type of hearing loss in Otitis media with effusion?
Conductive hearing loss
Management of Otitis media with effusion?
Re-evaluate in 3-6 months
ABT and decongestants -- not effective
Any degree of impairment in the ability to apprehend sound.
Types of hearing loss
Causes of conductive hearing loss (4)
Causes of sensorineural hearing loss (4)
Med toxicity - vanco, gent
Which is greater AIR conduction or BONE conduction
by how much?
AIR conduction > BONE conduction
air conduction should be TWICE as long as bone
What test compares air and bone conduction?
Normal findings in Rinne test?
AC > BC
Normal findings in Weber test?
sound equal in both ears
Conductive hearing loss -
Weber - sound is louder in AFFECTED ear
Rinne - abnormal (BC > AC)